血清HMGB1、SAA水平及CAMI-STEMI评分对STEMI患者PCI术后生存状况的预测价值
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摘要
目的探讨血清高迁移率族蛋白B1(high mobility group box 1 protein, HMGB1)、血清淀粉蛋白A(serum amyloid A protein,SAA)水平及中国心肌梗死注册登记研究-ST段抬高型心肌梗死(China acute myocardial infarction registry-ST segment elevation myocardial infarction,CAMI-STEMI)评分对ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后生存状况的预测价值。方法选取2015年1月至2017年12月于首都医科大学附属北京友谊医院行PCI的269例STEMI患者为研究对象,根据PCI术后6个月内有无发生主要不良心脏事件(major adverse cardiovascular events,MACE)将其分为预后不良组和预后良好组。比较两组患者术前血清HMGB1、SAA水平及CAMI-STEMI评分,采用ROC曲线下面积(area under curve,AUC)评价三者对PCI术后MACE的预测价值,采用多因素COX回归分析探讨患者PCI术后出现MACE的独立预测因素。结果 269例患者PCI术后6个月内共有51例(19.0%)出现MACE,包括支架内再发血栓28例,再发心肌梗死10例,恶性心律失常7例,心力衰竭5例,心源性死亡1例。预后不良组患者年龄显著大于预后良好组(P <0.05),术前血白细胞、空腹血糖、尿酸、超敏C反应蛋白、血清HMGB1、SAA水平、CAMI-STEMI评分、血管梗死位于近段的比率均显著高于预后良好组(均P <0.05),发病至心肌再灌注时间显著长于预后良好组(P <0.05)。术前血清HMGB1、SAA水平、CAMI-STEMI评分对MACE发生具有中等预测价值(AUC分别为0.786、0.760、0.853),三者联合对STEMI患者PCI术后MACE发生的预测价值更高。多因素COX回归分析结果表明,梗死位于血管近段、发病至心肌再灌注时间、术前血清HMGB1、SAA水平、CAMI-STEMI评分均为STEMI患者PCI术后MACE出现的独立预测因素(均P <0.05)。结论术前血清HMGB1、SAA水平及CAMI-STEMI评分均为STEMI患者PCI术后生存状况的独立预测因素,其中CAMI-STEMI评分价值最高,三者联合的预测效果更佳,值得临床推广应用。
Objective To investigate the predictive value of serum high mobility group box 1 protein(HMGB1), serum amyloid A protein(SAA) level and China acute myocardial infarction registry-ST segment elevation myocardial infarction(CAMI-STEMI)score for survival in patients with ST-segment elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI). Method 268 patients with STEMI received PCI in Beijing Friendship Hospital, Capital Medical University from January2015 to December 2017 were enrolled for the study and divided into poor prognosis group and good prognosis group according to the occurrence of major adverse cardiovascular events(MACE) within 6 months after PCI. Preoperative serum HMGB1, SAA levels and CAMI-STEMI score were compared between two groups. Area under curve(AUC) of receiver operating curve(ROC) was perfomed to evaluate the predictive value of three factors for MACE after PCI. Multivariate COX regression was used to analyze the independent predictors of MACE after PCI. Result A total of 51 patients(19.0%) suffered from MACE within 6 months after PCI,included 28 cases with recurrent stent thrombosis, 10 cases with recurrent myocardial infarction, 7 cases with malignant arrhythmia,5 cases with heart failure and 1 case with cardiac death. The age of patients in poor prognosis group was significantly older than that in good prognosis group(P<0.05), and preoperative white blood cells, fasting blood sugar, uric acid, high-sensitivity C-reactive protein, serum levels of HMGB1, SAA, CAMI-STEMI score and the ratio of infarction located in the proximal segment of blood vessel were significantly higher in good prognosis group(all P<0.05), and the duration from onset to myocardial reperfusion was significantly longer than that in good prognosis group(P<0.05). Preoperative serum HMGB1, SAA level and CAMI-STEMI score had moderate predictive value for occurrence of postoperative MACE(AUC were 0.786, 0.760, 0.853 respectively), and combination of these three factors had higher predictive value for occurrence of postoperative MACE. Multivariate COX regression analysis result showed that infarction located in the proximal segment of blood vessel, duration from onset to myocardial reperfusion, preoperative serum HMGB1, SAA level and CAMI-STEMI score were the independent influencing factors for MACE in patients with STEMI after PCI(all P<0.05). Conclusion Preoperative serum levels of HMGB1, SAA and CAMI-STEMI score are the independent predictors of survival in patients with STEMI after PCI, in which the value of CAMI-STEMI score is the highest, and the combined predictive effect of these three factors is better, which is worthy of clinical application.
Objective To investigate the predictive value of serum high mobility group box 1 protein(HMGB1), serum amyloid A protein(SAA) level and China acute myocardial infarction registry-ST segment elevation myocardial infarction(CAMI-STEMI)score for survival in patients with ST-segment elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI). Method 268 patients with STEMI received PCI in Beijing Friendship Hospital, Capital Medical University from January2015 to December 2017 were enrolled for the study and divided into poor prognosis group and good prognosis group according to the occurrence of major adverse cardiovascular events(MACE) within 6 months after PCI. Preoperative serum HMGB1, SAA levels and CAMI-STEMI score were compared between two groups. Area under curve(AUC) of receiver operating curve(ROC) was perfomed to evaluate the predictive value of three factors for MACE after PCI. Multivariate COX regression was used to analyze the independent predictors of MACE after PCI. Result A total of 51 patients(19.0%) suffered from MACE within 6 months after PCI,included 28 cases with recurrent stent thrombosis, 10 cases with recurrent myocardial infarction, 7 cases with malignant arrhythmia,5 cases with heart failure and 1 case with cardiac death. The age of patients in poor prognosis group was significantly older than that in good prognosis group(P<0.05), and preoperative white blood cells, fasting blood sugar, uric acid, high-sensitivity C-reactive protein, serum levels of HMGB1, SAA, CAMI-STEMI score and the ratio of infarction located in the proximal segment of blood vessel were significantly higher in good prognosis group(all P<0.05), and the duration from onset to myocardial reperfusion was significantly longer than that in good prognosis group(P<0.05). Preoperative serum HMGB1, SAA level and CAMI-STEMI score had moderate predictive value for occurrence of postoperative MACE(AUC were 0.786, 0.760, 0.853 respectively), and combination of these three factors had higher predictive value for occurrence of postoperative MACE. Multivariate COX regression analysis result showed that infarction located in the proximal segment of blood vessel, duration from onset to myocardial reperfusion, preoperative serum HMGB1, SAA level and CAMI-STEMI score were the independent influencing factors for MACE in patients with STEMI after PCI(all P<0.05). Conclusion Preoperative serum levels of HMGB1, SAA and CAMI-STEMI score are the independent predictors of survival in patients with STEMI after PCI, in which the value of CAMI-STEMI score is the highest, and the combined predictive effect of these three factors is better, which is worthy of clinical application.
引文
[1]高岩峰.不同时间窗冠状动脉介入对急性心肌梗死心肌酶、左室功能及远期预后的影响[J].转化医学电子杂志,2017,4(1):41-44.
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[3]刘波辉,杨金凤.HMGB1与脑缺血再灌注损伤机制[J].医学临床研究,2016,33(3):552-554.
[4]苟燕.血液透析联合血液灌流对糖尿病肾病患者微炎症状态的作用[J].医学临床研究,2017,34(3):493-495.
[5]Song F,Yu M,Yang J,et al.Symptom-Onset-To-Balloon Time,ST-Segment Resolution and In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention in China:From China Acute Myocardial Infarction Registry[J].Am J Cardiol.2016,118(9):1334-1339.
[6]Peiyuan H,Jingang Y,Haiyan X,et al.The Comparison of the Outcomes between Primary PCI,Fibrinolysis,and No Reperfusion in Patients≥75 Years Old with ST-Segment Elevation Myocardial Infarction:Results from the Chinese Acute Myocardial Infarction(CAMI)Registry[J].PLo S One,2016,11(11):e0165672.
[7]Fu R,Song C,Yang J,et al.CAMI-NSTEMI Score-China Acute Myocardial Infarction Registry-Derived Novel Tool to Predict In-Hospital Death in Non-ST Segment Elevation Myocardial Infarction Patients[J].Circ J,2018,82(7):1884-1891.
[8]Song C,Fu R,Dou K,et al.The CAMI-score:A Novel Tool derived From CAMI Registry to Predict In-hospital Death among Acute Myocardial Infarction Patients[J].Sci Rep,2018,8(1):9082.
[9]Yang JG,Liu HF,Xu HY,et al.Simple risk prediction model to assess hospital mortality in chinese patients with st elevation myocardial infarction based on a machine learning approach:from china acute myocardial infarction(CAMI)[J].Eur Heart J,2017,38(Suppl):1199.
[10]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[11]罗二飞,鄢高亮,钱昊,等.血红蛋白水平及CAMI-STEMI评分对急性ST段抬高型心肌梗死患者PCI术后预后的预测价值[J].东南大学学报(医学版),2018,37(3):471-476.
[12]Yu Y,Tang D,Kang R.Oxidative stree-mediated HMGB1biology[J].Front Physiol,2015,6(4):93.
[13]Xu J,Jiang Y,Wang J,et al.Macrophage endocytosis of highmobility group box1 triggers pyroptosis[J].Cell Death Differ,2014,21(8):1229-1239.
[14]张巍,石蓓,许官学,等.冠心病患者介入治疗前后血清CGRP、HMGB1变化及其与支架内再狭窄的关系[J].中国老年学杂志,2017,37(23):5803-5805.
[15]杨利娇,王虹,韩婷婷,等.高迁移率族蛋白B1与GRACE评分对行择期PCI治疗的急性冠脉综合征患者预后的影响[J].实用医学杂志,2018,34(2):254-258.
[16]金鹏,周琪,康美丽,张敏莉,朱铭,芦涤.早期HMGB1水平与AMI患者行急诊PCI院内发生心力衰竭的相关性[J].心脏杂志,2017,29(4):431-434.
[17]赵锐,李艳,戴雯,等.血清淀粉样蛋白A检测在冠心病诊断中的意义[J].检验医学与临床,2015,12(24):3657-3659.
[18]朱国富,李希杰,阮志敏,等.血清淀粉样蛋白A与老年冠心病患者冠状动脉病变严重程度的相关性分析[J].中华老年心脑血管病杂志,2016,18(11):1161-1164.
[19]董西刚.急性冠脉综合征患者SAA水平增高的临床意义[D].昆明:昆明医科大学,2012.
[20]陈强,陈丽珠,张娟,等.冠心病患者PCI术后24 h血清hsCRP、SAA水平对支架内再狭窄的预测价值[J].山东医药,2018,58(4):48-50.
[2]石苗苗,朱巧燕,王贵鹏,等.不同剂量氯吡格雷和阿司匹林联用对急性ST段抬高心肌梗死行PCI患者疗效的影响[J].转化医学电子杂志,2016,3(11):14-16,20.
[3]刘波辉,杨金凤.HMGB1与脑缺血再灌注损伤机制[J].医学临床研究,2016,33(3):552-554.
[4]苟燕.血液透析联合血液灌流对糖尿病肾病患者微炎症状态的作用[J].医学临床研究,2017,34(3):493-495.
[5]Song F,Yu M,Yang J,et al.Symptom-Onset-To-Balloon Time,ST-Segment Resolution and In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention in China:From China Acute Myocardial Infarction Registry[J].Am J Cardiol.2016,118(9):1334-1339.
[6]Peiyuan H,Jingang Y,Haiyan X,et al.The Comparison of the Outcomes between Primary PCI,Fibrinolysis,and No Reperfusion in Patients≥75 Years Old with ST-Segment Elevation Myocardial Infarction:Results from the Chinese Acute Myocardial Infarction(CAMI)Registry[J].PLo S One,2016,11(11):e0165672.
[7]Fu R,Song C,Yang J,et al.CAMI-NSTEMI Score-China Acute Myocardial Infarction Registry-Derived Novel Tool to Predict In-Hospital Death in Non-ST Segment Elevation Myocardial Infarction Patients[J].Circ J,2018,82(7):1884-1891.
[8]Song C,Fu R,Dou K,et al.The CAMI-score:A Novel Tool derived From CAMI Registry to Predict In-hospital Death among Acute Myocardial Infarction Patients[J].Sci Rep,2018,8(1):9082.
[9]Yang JG,Liu HF,Xu HY,et al.Simple risk prediction model to assess hospital mortality in chinese patients with st elevation myocardial infarction based on a machine learning approach:from china acute myocardial infarction(CAMI)[J].Eur Heart J,2017,38(Suppl):1199.
[10]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[11]罗二飞,鄢高亮,钱昊,等.血红蛋白水平及CAMI-STEMI评分对急性ST段抬高型心肌梗死患者PCI术后预后的预测价值[J].东南大学学报(医学版),2018,37(3):471-476.
[12]Yu Y,Tang D,Kang R.Oxidative stree-mediated HMGB1biology[J].Front Physiol,2015,6(4):93.
[13]Xu J,Jiang Y,Wang J,et al.Macrophage endocytosis of highmobility group box1 triggers pyroptosis[J].Cell Death Differ,2014,21(8):1229-1239.
[14]张巍,石蓓,许官学,等.冠心病患者介入治疗前后血清CGRP、HMGB1变化及其与支架内再狭窄的关系[J].中国老年学杂志,2017,37(23):5803-5805.
[15]杨利娇,王虹,韩婷婷,等.高迁移率族蛋白B1与GRACE评分对行择期PCI治疗的急性冠脉综合征患者预后的影响[J].实用医学杂志,2018,34(2):254-258.
[16]金鹏,周琪,康美丽,张敏莉,朱铭,芦涤.早期HMGB1水平与AMI患者行急诊PCI院内发生心力衰竭的相关性[J].心脏杂志,2017,29(4):431-434.
[17]赵锐,李艳,戴雯,等.血清淀粉样蛋白A检测在冠心病诊断中的意义[J].检验医学与临床,2015,12(24):3657-3659.
[18]朱国富,李希杰,阮志敏,等.血清淀粉样蛋白A与老年冠心病患者冠状动脉病变严重程度的相关性分析[J].中华老年心脑血管病杂志,2016,18(11):1161-1164.
[19]董西刚.急性冠脉综合征患者SAA水平增高的临床意义[D].昆明:昆明医科大学,2012.
[20]陈强,陈丽珠,张娟,等.冠心病患者PCI术后24 h血清hsCRP、SAA水平对支架内再狭窄的预测价值[J].山东医药,2018,58(4):48-50.